Provider Demographics
NPI:1881478873
Name:SMITH, AMY KATHERINE
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:KATHERINE
Last Name:SMITH
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 COUNTY ROAD 617
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:AL
Mailing Address - Zip Code:35648-4120
Mailing Address - Country:US
Mailing Address - Phone:256-710-6343
Mailing Address - Fax:
Practice Address - Street 1:3515 CLOVERDALE RD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35633-1301
Practice Address - Country:US
Practice Address - Phone:256-284-7706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-22
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN34412363L00000X
AL1-139596363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner